Keloid Disorder: An Overview

Keloid Disorder is not a condition that can be effectively treated with surgery. In fact, many patients experience a worsening of their keloids after surgical intervention. This phenomenon occurs because keloids stem from a genetic disorder affecting the wound healing mechanisms of the skin. After an injury—such as an ear piercing or a cut—the body initiates a wound healing response. However, in individuals with keloid disorder, this response continues excessively, failing to cease once adequate healing has occurred. This abnormal persistence of the wound healing process ultimately leads to the formation of keloids.

While many people undergo ear piercings, only a select few develop ear keloids. This susceptibility is due to the presence of a genetic predisposition. When a surgeon removes an ear keloid, the incision creates a larger wound than the original piercing, resulting in a more significant injury. The larger the injury, the greater the likelihood of developing a larger subsequent keloid. Although surgical intervention may benefit some keloid patients, a significant number experience a marked worsening of their keloids post-surgery. While keloids can be observed across various ethnic backgrounds, they are more prevalent among African, African American, and Asian populations.

Keloid Disorder manifests in a diverse array of appearances. It can present as a single small lesion or as multiple large keloids in various locations on the body. In some cases, keloid lesions can grow to form sizable skin tumors. The progression of keloids can vary significantly among patients; some may develop only one keloid that reaches a certain size before ceasing to grow, while others may begin with a single keloid and subsequently develop multiple additional lesions.

Despite being recognized for centuries, Keloid Disorder remains one of the most under-researched and poorly understood medical conditions. Key areas such as genetics, epidemiology, and pathophysiology are not well-studied. Additionally, there is a lack of proper terminology and nomenclature surrounding the disorder. Many erroneously refer to keloids as "scars" or "keloid scars." This misnaming can lead to complications with insurance coverage, as many insurers do not reimburse for the treatment of scars, viewing treatment of keloids as cosmetic procedures.

EPIDEMIOLOGY

Like many other aspects of Keloid Disorder, its epidemiology, including true incidence and prevalence, has never been properly studied. The exact incidence and prevalence of keloids in the United States are unknown. Unfortunately, the Centers for Disease Control and Prevention (CDC) does not monitor this disorder, leaving us without reliable data on its occurrence in the country. Similarly, the World Health Organization (WHO) does not track Keloid Disorder. However, it is known to be relatively common in sub-Saharan Africa and Asia.

GENETIC PREDISPOSITION

Most keloid patients have a positive family history of keloid disorder, and the occurrence of keloids among twins further supports the notion of genetic susceptibility. However, the genetic basis of keloid disorder remains poorly understood and is an area that has not been adequately researched.

PATHOGENESIS

The pathogenesis of keloid disorder is largely unknown and poorly understood. The formation of keloid lesions begins with a wound to the skin in individuals with a genetic predisposition. This disruption in the normal anatomy of the skin, combined with genetically driven dysregulated wound healing, leads to the development of keloid lesions. The worsening of keloids after surgical excision is likely due to the activation of these dysregulated wound healing mechanisms in response to a new, more extensive dermal injury, such as that from surgery.

Another significant factor in the pathogenesis of keloids is the age of onset, which peaks during puberty and early adolescence. This topic is discussed in more detail on this website.

We hope this brief overview provides you with a foundational understanding of keloid disorder. Please explore this website for more valuable information and links to reputable resources.

The video below summarizes keloid disorder as presented by Dr. Tirgan at a medical meeting.

Michael H. Tirgan, MD